Casazza F, Faorista F, Donatelli F, Grossi A
Divisione di Cardiologia-Azienda Ospedaliera S. Carlo Borromeo-Milano.
G Ital Cardiol. 1996 Feb;26(2):207-11.
The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.
作者报告了一名47岁患有细菌性心内膜炎的女性，累及二尖瓣和主动脉瓣。初次超声心动图检查时，二尖瓣赘生物较小，而主动脉瓣赘生物较大且活动度高。尽管进行了充分的抗生素治疗，主动脉瓣赘生物仍变大，瓣膜反流最初为轻度至中度，后来发展为重度，并伴有左心衰竭。在等待手术期间，患者发生急性非Q波心肌梗死，下壁和前侧壁导联ST段抬高，并发室性心律失常。36小时后，患者接受了二尖瓣和主动脉瓣置换术：手术中发现主动脉瓣赘生物非常靠近右冠状动脉口。经过一段时间的进一步抗生素治疗后，该女性出院，六个月随访时情况良好。作者回顾了感染性心内膜炎中急性冠状动脉供血不足的机制，并认为所报告病例存在栓塞性发病机制。考虑到可能危及生命的栓塞并发症，当抗生素治疗未能减小瓣膜赘生物的大小和活动度时，不延迟手术似乎是合理的。
